No room for shaming in public health system

In a recent article, Nova Scotia’s Health Minister, Leo Glavine, floated the idea that people should have to demonstrate healthy lifestyles before accessing our health care system, much like a bank assesses a customer for a loan.

Sadly, this is not a new idea but has been floated by others pundits and politicos over the years, often couched in the language of practicality and common sense. Healthcare is a privilege to be earned, not a right, they lobby.

Healthcare just for the healthy, in other words. Here’s why such an idea would fail — for all of us.

Not only would restricted health care access be unkind, it would be unwise, as this kind of barrier would result in people presenting later and sicker to hospital, incurring higher system costs — costs that would inevitably be borne by Canadian taxpayers.

We are relieved that Glavine quickly recognized that a system based on the kind of pre-approval requested for bank loans would be inhumane. But why float the idea in the first place? Our public health care system is there to help address inequality in our society by providing equal access to care for all — not to shame the sick. An entire population’s health declines as inequity increases, even in a wealthy country like Canada.

Of course, it would be better for all people in Canada to eat healthy food, stop smoking and exercise more. As a doctor, I absolutely recommend those actions. However, it’s often easier said than done. I also see first-hand exactly why it’s difficult for many of my patients to make healthy choices.

It’s difficult for some patients to afford the pharmaceuticals that keep their diabetes under control when they are already forced to choose between rent or putting food on the table.

It’s difficult for some patients to buy nutritious foods — or it’s hard to find the time to cook when they’re working multiple, part-time jobs. It’s hard to give up smoking when everyone in your family smokes and you’ve been addicted since you were 14 years old.

We don’t need the health police, and we don’t need a health bank. We don’t need “get tough” messages about personal responsibility if we’re not going to support better personal choices.

What does the evidence say?

We know, for example, that anti-smoking programs had no effect when we wagged our fingers at smokers but they had great effect when we used integrated strategies in public education, primary care and public health.

What we need is a health care system that’s based on need, not ability to pay. But we also need social policies that create the conditions for good health.

The evidence also shows us that lifestyle choices such as decreasing smoking, exercise and good diet increase proportionally to an individual’s social and economic status. In other words, improving lifestyles is more about improving inequality within a society and less about criticizing people for poor choices.

There’s no point in singling out those individuals who are “dependent” on our health care system. In truth, we are all dependent on our health care system to take care of us when we are ill or injured. And it’s a value we share in Canada, to take care of each other through our health care system.

In fact, our health care system is an important tool we have to combat inequality in our society by providing equal access to care for all.

Medicare lets people get their health back without the added burden of financial ruin, preventing a spiral into poorer health and poverty that affects society as a whole.

We need to think beyond simplistic prevention messages and reactive health care. We need to include serious efforts to reduce poverty, provide affordable, quality housing and work to overcome systemic marginalization and discrimination.

It’s a basic principle of health: if you treat the symptoms and not the underlying condition, your patient won’t get better. It’s time to stop pointing the finger at individuals and look instead toward policies that recognize the evidence and create the conditions for Canadians to make healthier choices.

Dr. Ryan Meili is the Director of Upstream, an expert adviser with, a Saskatoon doctor and the author of A Healthy Society.


Showing 1 reaction

  • Fiona McMurran
    commented 2014-04-24 20:46:27 -0600
    I was appalled at this suggestion — what has happened to the country that brought in a unique single-payer health system? Nevertheless, I do find myself wondering when and how we are going to transition from a system focussed on illness to one focussed on health. For instance, my family of three adults (our adult autistic daughter lives with us) subsist on my basic government pension. We buy our food locally and eat wisely. We take advantage of affordable fitness programs at our local community centre. But food prices are soaring. Gas prices to heat our home go up 40% on May 1. The lack of a regional public transportation system means giving up our car really isn’t an option, when so many service providers are outside our locality. Governments pay lip service to “wellness”, but they don’t budget to enable it. The established “big players” — the hospitals, in particular — dominate the discourse. But real health is local. It’s about community empowerment.
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